EP3586783A2 - Trocar holder - Google Patents
Trocar holder Download PDFInfo
- Publication number
- EP3586783A2 EP3586783A2 EP19178340.6A EP19178340A EP3586783A2 EP 3586783 A2 EP3586783 A2 EP 3586783A2 EP 19178340 A EP19178340 A EP 19178340A EP 3586783 A2 EP3586783 A2 EP 3586783A2
- Authority
- EP
- European Patent Office
- Prior art keywords
- clamp
- axis
- trocar
- legs
- trocar holder
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Granted
Links
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- 230000001954 sterilising effect Effects 0.000 claims description 11
- 238000004659 sterilization and disinfection Methods 0.000 claims description 11
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Images
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3403—Needle locating or guiding means
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
- A61B17/3421—Cannulas
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
- A61B17/3421—Cannulas
- A61B17/3423—Access ports, e.g. toroid shape introducers for instruments or hands
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3462—Trocars; Puncturing needles with means for changing the diameter or the orientation of the entrance port of the cannula, e.g. for use with different-sized instruments, reduction ports, adapter seals
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/30—Surgical robots
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/70—Manipulators specially adapted for use in surgery
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/50—Supports for surgical instruments, e.g. articulated arms
- A61B90/57—Accessory clamps
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00367—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00477—Coupling
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3403—Needle locating or guiding means
- A61B2017/3405—Needle locating or guiding means using mechanical guide means
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B2017/348—Means for supporting the trocar against the body or retaining the trocar inside the body
- A61B2017/3492—Means for supporting the trocar against the body or retaining the trocar inside the body against the outside of the body
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/30—Surgical robots
- A61B2034/302—Surgical robots specifically adapted for manipulations within body cavities, e.g. within abdominal or thoracic cavities
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B46/00—Surgical drapes
- A61B46/10—Surgical drapes specially adapted for instruments, e.g. microscopes
Definitions
- the invention relates to a trocar holder for a manipulator of a robotic operating system.
- a trocar holder for a manipulator of a robotic operating system.
- Such a trocar holder comprises a base element for fastening the trocar holder to the manipulator.
- it comprises a clamp element with two legs, which is connected to the base element in an exchangeable manner via a coupling mechanism.
- the two legs are movable relative to each other and connected to each other by a back, they are designed with free tips.
- the trocar holder comprises a clamp mechanism for opening and closing the legs and thus the clamp.
- Robotic operating systems are nowadays used for an increasing number of minimally invasive operations, particularly in places that are difficult to access.
- Such an operating system usually comprises a number of manipulator arms which are coupled at one end to a supporting device and have an instrument carrier device at their other end. Together they form a manipulator. It is controlled via a control panel, which does not necessarily have to be in the immediate vicinity of the manipulators.
- the operator ie the surgeon, usually operates a number of robotically controlled arms via the control panel, which hold the instruments in order to carry out individual steps of an operation.
- the surgeon controls the manipulator arms of the system via the control panel or by appropriate movements via a suitable coupling mechanism that converts movements of the surgeon's hands into movements of the corresponding instrument.
- the manipulators are multi-part systems in which the individual parts are connected to each other via joints. Some of the links serve to position the manipulator relative to other manipulators of the same robotic system, so that the manipulators do not interfere with one another.
- This part of the links is also referred to as an actuating device, the positioning described takes place before the operation and is therefore also referred to as pre-positioning.
- Another part of the links is used for positioning and guiding the tool on the object, for example for positioning a surgical instrument or an endoscope in the region of an opening in the tissue cover of a patient.
- This part of the links is also referred to as an instrument carrier device.
- the links of a manipulator are connected in the kinematic sense as an open kinematic chain, since there is no other joint on the last link, but the tool. All other links are connected to each other like a chain via joints.
- trocars are used to carry out minimally invasive interventions, which are medical instruments that are used to initially access the body, for example the abdominal cavity. This access is then kept open by means of the trocar, which has the shape of a tube.
- the tube is used to introduce surgical instruments into the body, but also from endoscopic cameras.
- the trocar should not change its position during the operation, i.e. remain stable in a predetermined position unless otherwise required.
- Trocars are also placed in robotic operating systems and held in position during the operation.
- the instrument carrier devices are usually equipped with a trocar holder, through which the instrument can then be guided into the body.
- the trocar holders After the trocar holders have been pre-positioned on the various manipulators of the robotic operating system, the trocars and then the instruments can be inserted. It is important to ensure that the load on the tissue where the trocars are inserted is kept as low as possible.
- the area of the trocar holders and trocars must be kept sterile.
- Trocars can be designed as single-use or reusable components, the same applies to the trocar holders. It is important that the trocar holders can also be changed, for example to prepare a new operation or to set up another trocar.
- the clamp element is attached to the manipulator via the base element in such a way that a relative movement between the two in the assembled or connected state is excluded, since the base element may also be used to produce an electrical contract with an instrument guide or with the manipulator, which for example, an electrical opening and closing of the clip allowed.
- a sterilization film or a similar means which ensures this condition is inserted into the clamp, which then holds the trocar. Since the Trocar holder itself is not sterile and is nevertheless kept relatively close to the patient, so there is an increased risk of infection in some cases.
- trocar holders with which the trocar can generally be positioned relative to a patient are known in the prior art.
- WO 03/092518 A1 In the WO 03/092518 A1 are shown in Fig. 11.AD different clip devices with which a trocar can be fixed in a corresponding opening of the closed clip. The instrument itself can then be moved along the trocar axis, which is referred to as the z axis.
- Fig. 11.E the WO 03/092518 A1
- a coupling mechanism designed as a quick-release fastener for coupling the clamp element to an axially rotatable shaft is also shown.
- the coupling mechanism comprises a plug connection between the clamp element and the rotatable shaft and a sliding sleeve with a holding position, which encloses areas of a shaft of the clamp element and of the rotatable shaft.
- the rotatable shaft is connected to a motor by means of a bevel gear and can be rotated axially.
- the in the WO 03/092518 A1 the trocar holder described is not intended for use in a robotic system, but is only used for the stable positioning of a trocar during laparoscopic operations.
- EP 3 111 876 A2 describes a stapling device that can be used with a robotic operating system.
- the clamp device directly holds a trocar or trocar holder in the closed state, and it has a lever mechanism for opening and closing the clamp, as is the case, for example, in FIGS. 19A and 19B EP 3 111 876 A2 demonstrated.
- the inside of the clip can be lined with a sterile cloth. A safe posture is only possible for a certain trocar diameter or a certain diameter of a trocar holder.
- the clamp can be connected to a manipulator arm via a base element.
- the trocar or trocar holder can only be moved in the axial direction; all other settings must be made with the manipulator arm itself, to which the base element is firmly attached.
- An adaptation to different trocar diameters is possible in the sense that only the head of a trocar holder is fixed in the clamp itself, to which a tube connects, which usually has a much smaller diameter than the head, so that different diameters can be realized can.
- FIGS. 11, 12 and 15 show a trocar 800 which is tiltably mounted on a trocar holder 17.
- a device for easily changing the trocar or trocar holder is not provided.
- the tiltability enables a more compact design and puts less strain on a patient's tissue.
- the object of the invention is to further develop a trocar holder for a robotic operating system of the type described at the outset in such a way that, on the one hand, there is an easy interchangeability, and adaptation to different diameters of trocars can be implemented in a simpler manner, with an equally secure hold being ensured for all diameters should be kept as low as possible.
- this object is achieved in the case of a trocar holder of the type described in the introduction in that the trocar holder comprises a receiving element for a trocar.
- the legs are opened and closed; when the legs are open, the trocar and the receiving element can be removed and replaced, for example.
- receptacle elements for different trocars can be exchanged without special effort, for example, a receptacle element for a trocar that is intended to hold a scalpel can be exchanged for a thicker one for an endoscope.
- the receiving elements can be optimally adapted to the various trocars, the best possible hold is always given.
- the receiving elements can in particular also be firmly connected to the trocars, for example by being made in one piece, preferably from plastic.
- the receiving element When the legs are closed, the receiving element is preferably held rotatably about a first axis of rotation lying in the plane of the clamp.
- a degree of freedom for the trocar holder is realized in such a way that it can be pivoted about a pivot point on its longitudinal axis, which enables a more compact structure and a reduction in the tissue load on the patient when the trocar is inserted.
- a so-called radial bearing is formed in the region of the tips of each of the two legs, that is to say a bearing which prevents radial movement for a shaft or axis, as well as axial movement in one direction along the axis, for example with the aid of a stop ,
- the receiving element itself is in this case designed as an axis and is clamped by the two radial bearings, so that the receiving element is prevented from axial movement by the radial bearings when the legs are closed.
- the receiving element has a continuous opening perpendicular to the axis.
- the opening can be a simple annular opening, the inside diameter of which corresponds approximately to the outside diameter of the trocar.
- different receiving elements can be used which have different diameters. In this way, the trocar is always optimally held in the receiving element and thus in the trocar holder, since an adaptation to different diameters can be implemented precisely and without special effort by means of different receiving elements. This increases safety in the handling of the operating system.
- Conventional trocars for robotic operating systems have an instrument holder with a rather large diameter and an adjoining lead-through element with a smaller diameter than the instrument holder; the lead-through element is usually designed as a cylindrical tube.
- the instrument is therefore at least prevented from slipping by the instrument holder, it is stored therein and, if necessary, also fixed.
- the tube is not cylindrical, but in which the lead-through element has the shape of a truncated cone that tapers away from the instrument holder - that is, away from the instrument holder - with the cone angle chosen to be extremely narrow becomes so that a difference to the cylindrical shape is barely visible to the naked eye, the penetration depth of the trocar can be controlled to a limited extent and at least limited by means of the diameter of the through opening in the receiving element.
- the coupling mechanism for the connection between the base element and the clamp element is preferably designed as a quick-release fastener, which can be operated by hand without further aids.
- a snap connection is particularly suitable.
- the base element is then firmly mounted on the manipulator and the clip element is fixed to the base element by means of the snap connection, a relative movement between the base element and the clip element is then excluded.
- the clamp element itself can then be operated mechanically, ie by hand.
- a sterile separation between the clamp element and the base element can be achieved by inserting a sterilization film between the two before the connection between the two elements is established. This can, for example, be held clamped between the two elements or be detachably or firmly connected to the clamp element.
- the sterility area can be further removed from the patient compared to the prior art, which improves the hygienic safety. Therefore all parts on the side of the sterilization film facing the patient must be sterile, which includes at least the receiving element, the clamping element and the clamping mechanism; of course also the trocar.
- At least the receiving element, the clamp element and the base element are made of plastic.
- the design made of plastic makes it possible to reduce the production costs and at least the clip element and the receiving element also as disposable parts, i.e. for single use, to be provided, which further improves the hygienic conditions.
- the two legs and the back of the clamp element are particularly preferably formed in one piece.
- the clip formed from legs and back advantageously has a spring action, which leads to the legs being deflected from a rest position with elastic deflection , a zero position at which there is no restoring force, spring back elastically into it, provided the force required for the deflection subsides or they are no longer held in their deflected position.
- At least one of the legs is therefore advantageously connected to the back in a resilient manner.
- the elastic deflection from the zero position takes place by means of force, which can be exerted, for example, by the clamp mechanism.
- the clamp mechanism can be implemented in various ways, taking care that the receiving element is held securely with the trocar and is protected against unintentional loosening.
- the clamp mechanism comprises at least one pin which is fixed in the leg in question at an angle to the clamp plane which is different from zero.
- the clamp mechanism then comprises a guide element which can be moved along or about a movement axis relative to the clamp element and into which at least one elongated hole with narrow sides and long sides is made.
- the number of elongated holes corresponds to the number of pins, and a pin can be provided in each of the legs.
- the at least one pin which is preferably made of metal, in particular stainless steel, is guided in the at least one elongated hole, the two narrow sides of the at least one elongated hole being at different distances from the axis of movement, so that the at least one leg - corresponding to the number of Pins - opens or closes when the guide element moves along or around the movement axis.
- Two pins are preferably used, ie one pin is fixed in each of the two legs, preferably perpendicular to the plane of the clamp. This increases stability and improves handling.
- the movement of the guide element results in a relative movement between the pin and the elongated hole, which is limited by the narrow sides of the elongated hole. If the pin is located on the narrow side closer to the axis of movement, the clamp or the relevant leg is closed. If the pin is on the other narrow side of the elongated hole, the clip or leg is open.
- the axis of movement lies in the plane of the brackets and is equally spaced from both - generally symmetrical - legs, that is, it lies exactly in the middle between the two.
- the guide element is designed as a guide slide which can be displaced along the movement axis.
- the at least one elongated hole can be made straight to be one with respect to the displacement, i.e. to achieve the distance covered, linear opening or closing of the bracket.
- Other curved elongated holes are possible, for example in order to reduce the force required when the opening increases, which means that the sliding distance of the slide increases for a predetermined angle as the opening increases, since the curvature is reduced.
- the clamp mechanism can be made even more compact if the movement axis is designed as a second axis of rotation, which includes an angle other than zero, preferably a right angle, with the clamp plane.
- the guide element can be rotated about the second axis of rotation, the at least one elongated hole — which is also referred to as the backdrop — being at least partially curved.
- the second axis of rotation preferably runs through the guide element.
- the pins in the two elongated holes are moved back and forth between the end positions, ie the narrow sides of the elongated holes, depending on the direction of rotation.
- Those narrow sides of the elongated holes which have the shortest radial distance from the second axis of rotation then define the state of a closed bracket or closed leg, the pins being closest to the second axis of rotation of the guide element.
- the other narrow sides, which are furthest away from the second axis of rotation, then define the position of the opened clamp or open leg. It is not absolutely necessary that both pins each reach the end positions, ie actually reach the narrow sides, that the movement of the guide element results in a relative movement of the two legs towards or away from each other if the direction of movement is reversed.
- a clamp mechanism is expedient and particularly easy to use, in which the pins - and in the event that the axis of movement is also designed as an axis of rotation, the axis of rotation - are arranged perpendicular to the plane of the clamp.
- the at least one pin can have an interference fit with respect to the at least one elongated hole, which is dimensioned such that mechanical displacement with little effort without effort of an operator still remains possible.
- the axis of movement is a second axis of rotation about which the guide element can be rotated
- the latter can particularly advantageously be rotatably attached to a tongue connected to the clamp element, which is particularly expediently fastened to the back of the clamp element.
- the tongue can be formed in one piece with the back.
- the rotatable guide element has the advantage over the displaceable one that it is always arranged in the same area of the clamp element, whereby a compact arrangement and also the attachment to the clamp element itself is possible in a simple, compact manner, this fixation additionally fixes and stabilizes the second axis of rotation the device further.
- the at least one elongated hole in the guide element in the region of the narrow side which is further away from the axis of movement on the longitudinal side which faces the axis of movement has a bulge in the direction of the axis of movement into which the at least one pin engages when the legs are open ,
- the guide element expediently has a lever for actuating the clamp mechanism, in particular if the movement axis is designed as a second axis of rotation.
- the lever then engages on one side with the axis of rotation and extends away from it in a substantially radial direction.
- the guide element is rotated about the axis of rotation.
- Fixing means corresponding to one another are formed, for example as a latching connection, by means of which the lever is secured in its position at least when the leg is closed. This further complicates the possibility of involuntary opening, but also secures the trocar holder against unintentional opening when accidentally touched.
- the lever is then preferably located in a projected plan view of the clamp plane within the contour of the clamp element or is flush with it, which also represents an additional safeguard against unintentional opening.
- the receiving element is firmly connected to a trocar (18) and is preferably manufactured in one piece with it. This can prevent the trocar from accidentally slipping out of the receiving element.
- a modification of the clamp mechanism with a guide element rotatable about the second axis of rotation including an angle different from the clamp plane results if, instead of pins, at least one eccentric element arranged eccentrically with respect to the second axis of rotation is attached to the guide element, so that during rotation of the guide element about the second axis of rotation at least one of the legs opens or closes by the action of the eccentric element.
- the eccentric element can be arranged or formed separately on the - preferably disc-shaped - guide element, but it can also be part of the lever handle in that it has a correspondingly varying curvature in the region in which it is connected to the guide element.
- the at least one eccentric element is then not in contact with the corresponding leg or is only in contact with it, so that the leg is not under prestress.
- the eccentric element is then guided into the region of the leg and presses it away from the second axis of rotation in the plane of the clamp.
- two eccentric elements are also used here, which, however, can be formed in one piece with the lever.
- Fig. 1 initially shows an overview of a robotic operating system.
- the support structure of the robotic operating system is shown, which rests on a base 1, on which a height-adjustable support column 2 with a bracket 3 projecting therefrom and a fork structure 4 are arranged at the free end of the bracket 3.
- a total of four manipulators 5 with instrument holders 6 are arranged on the boom 3 with the fork structure 4.
- a patient couch 7 is arranged on a couch pedestal 8, on which a patient 9 to be operated is located.
- the Patient couch 7 can be rotatably mounted on the couch stand 8.
- the support structure of the robotic operating system and the patient couch 7 can advantageously also be moved translationally relative to one another.
- the robotic operating system also has a control device 10 which is shown in FIG Fig. 1a ) is shown and is also relatively movable with respect to the support structure, can be moved here. It is operated by a specially trained surgeon, and the movements of the surgeon on handles 11 of the control device 10 are transmitted to the manipulators 5 or to instruments held in the instrument holders 6. The surgeon can monitor the operation field with the aid of a viewing device 12.
- the manipulator 5 is a multi-part system which corresponds to a loose kinematic chain.
- a part of the links forms a positioning device - also called a manipulator arm - and the remaining part of the links an instrument carrier device, the instrument holder 6 is mounted on the latter.
- Fig. 2 shows such an instrument carrier device 13, but without an instrument holder 6.
- the instrument holder 6 is coupled to the instrument carrier device 13 via a translatable carriage 14.
- the instrument carrier device 13 comprises a first arm member 15, with which the instrument carrier device 13 is coupled to the positioning device of the manipulator 5. It further comprises a second arm member 16, which is rotatable about a common longitudinal axis with respect to the first arm member 15.
- the second arm member 16 connects the first arm member 15 to a third arm member 17 which is rotatable about an axis oriented perpendicular to the common longitudinal axis of the first and second arm members.
- a trocar holder with a trocar 18 is attached to the tip of the second arm member 16, the trocar holder is described below essentially on the basis of the perspective views of FIG Figures 3 and 4 explained in more detail.
- the Fig. 5a ) -c) show individual parts of the trocar holder in detail
- 7 and 8 demonstrate opening and closing of the trocar holder.
- Fig. 3 shows the trocar holder Fig. 2 with a trocar 18, but without an instrument carrier device 13.
- the trocar holder comprises a base element 19 for fastening the trocar holder to the manipulator 5 or the instrument carrier device 13 of the manipulator 5.
- the trocar holder also comprises a clamp element 20, which is connected to the base element 19 in an interchangeable manner via a coupling mechanism is.
- Two limbs 21 with free tips 22, which are movable relative to one another in a clamp plane, are formed on the clamp element 20.
- the clip element 20 has a clip mechanism for Opening and closing of the legs 21.
- the legs 21 are connected at their ends opposite the tips 22 by means of a back 23.
- the trocar holder comprises a receptacle element 24 for the trocar 18, the receptacle element 24 is held rotatably about a first rotation axis lying in the clamp plane when the legs 21 are closed.
- the coupling mechanism for connecting the base element 19 to the clamp element 20 can be operated by hand without further aids and is designed as a quick-release fastener, here as a snap connection.
- a snap element 25, on which one or more snap lugs 26 are formed, is located on the clamp element 20.
- To quickly release the snap connection there are two mechanical pushbuttons 27 on the base element 19 which are pressed together to release the snap connection. This can be done with one hand, the other hand can hold the clamp element 20.
- a sterilization film is placed between the two, which is fixed by the snap connection in the assembled state.
- the two legs 21 are movable relative to one another in a bracket plane.
- the bracket level is the level in which the two legs lie and in which the relative movement of the legs is also generated by means of the bracket mechanism. At least one of the two legs is therefore moved when the clamp mechanism is actuated.
- the first axis of rotation, about which the trocar 18 can rotate, also lies in the plane of the bracket.
- a radiax bearing 28 is formed in the area of the tips 22 of each of the two legs 21.
- the receiving element 24 is designed as an axis and is prevented from moving axially by the radial bearings 28 when the legs are closed. For this purpose, it lies in the radial bearings 28 with axial end regions 29.
- the receiving element 24 has a continuous opening 30 for the passage of the trocar 18 perpendicularly through the axis. The trocar 18 is inserted into this.
- the receiving element 24 is interchangeable and can be of different sizes, i.e. can be provided with openings of different diameters. In this way, an optimal adaptation to the respective trocar 18 is always possible, since different trocars can be used for different instruments. For example, trocars for endoscopes are somewhat thicker than trocars for scissors or scalpels.
- the trocar 18 has an instrument receptacle 44, to which a feed-through element 45 adjoins.
- the lead-through element 45 has a tapered shape of a truncated cone projecting from the instrument holder 44.
- the cone angle is extremely acute, preferably less than 1 °, particularly preferably less than 0.1 °; In this way, a corresponding penetration depth can be specified: the more acute the cone angle, the higher the penetration depth if the same receiving element 24 is used. Since the cone shape is very pointed, a tight fit of the trocar 18 in the receiving element 24 is nevertheless made possible.
- the legs and the back of the clamp element are preferably formed in one piece and are preferably made of plastic. On the one hand, this enables low manufacturing costs and, on the other hand, the design of the clip element as a disposable item that is disposed of after each operation, which is hygienically advantageous.
- the clip formed from legs and back preferably has a spring action, which leads to the legs 21 being subjected to elastic deflection from a rest position, for example here in Fig. 5a ) can be shown, spring back elastically into it, provided that the force necessary for the deflection subsides or they are no longer held in their deflected position.
- At least one of the legs 21 is therefore advantageously connected to the back 23 to produce this spring action.
- the rest position can in principle be chosen freely and is not subject to any restrictions, for example in injection molding, ie the legs do not necessarily have to be in the rest position, as in Fig. 5a ) are shown in parallel, but can also run together or slightly diverge towards their tips 22.
- the receiving element 24 can in principle also be inserted by hand into the radiax bearing 28 at the tips 22 of the legs 21, but this is complex and cumbersome, and improper handling can also destroy the clip element 21.
- the trocar holder therefore also has a clamp mechanism for opening and closing the legs.
- the clip mechanism comprises at least one pin 31 which is fixed in a leg 21 at an angle to the clip plane that is different from zero.
- two pins 31 are shown by way of example, which are fixed in the legs 21 at angles other than zero to the plane of the clamp, in each leg 21 a pin 31, which can be made of stainless steel, for example, is fixed.
- These pins 31 are in the exploded view in Fig. 4 shown outside the leg 21 in Fig. 5a ) 6a-b ) 7 and 8 the pins 31 are inserted into the legs 21 and fixed there.
- the fixation can be non-positive, positive and / or take place cohesively.
- the pins 31 are non-positively and positively connected to the legs 21, they have a slight interference fit compared to the openings in the legs 21 into which they are driven.
- the clamp mechanism also comprises a guide element 32, into which a number of elongated holes 33 with narrow sides 34 and long sides 35 corresponding to the number of pins 31 are introduced.
- the guide element 32 therefore has two elongated holes 33, the guide element 32 is in Fig. 5c ) shown in a view from below.
- the guide element 32 is movable with respect to an axis of movement, the two pins 31 are guided in the elongated holes 33. Opening and closing of the legs 21 is achieved by the two narrow sides 34 of each elongated hole 33 being at different distances from the axis of movement.
- the axis of movement can be an axis of displacement which lies in the plane of the clamp and is equally spaced from both legs 21, ie intersects a point in the middle of the back and a point at half the distance between the two tips 22, that is to say parallel to the legs 21.
- the guide element is then designed, for example, as a slide and a movement of the at least one pin 21 relative to the elongated hole 33 from the narrow side closer to the axis of movement to the distant narrow side lying away from the axis of movement opens the leg 21 or the clamp, an opposite movement closes the clamp ,
- the at least one slot 33 is then at least partially curved.
- the two narrow sides 34 of each elongated hole 35 lie at different distances from the second axis of rotation, a rotation of the guide element 32 - shown for example in FIG Fig.
- the legs 21 are in their rest position, ie there are no internal restoring forces due to structure.
- the area of the at least one elongated hole 33, which is closer to that narrow side 34, which in turn is closer to the second axis of rotation 36 and defines the closed state of the clip as is straight section 37 of the elongated hole 33, this straight section 37 has no curvature and acts as a so-called dead area, since no adjustment takes place in this area. In this way, possible manufacturing tolerances can be taken into account and it can be ensured that the guide element 32 can be brought into a rest position and fixed there.
- the pins 31 are arranged here perpendicular to the plane of the clamp, as is the second axis of rotation 36.
- the pins 31 can have a slight interference fit with respect to the elongated holes 33 in order to prevent involuntary adjustment.
- the guide element 32 can also be fixed in the two end positions, which define the maximum possible opening and the closed clamp.
- the elongated holes 33 located closer to the axis of movement have a bulge 38 in the area of those narrow sides 34 which correspond to the opened clamp, into which the respective pin 31 due to the intrinsic restoring force of the clip.
- the guide element 32 is shown on a tongue 39 connected to the clamp element 20, for example in FIG Fig. 5a ) Fig. 6b ) and Fig. 8 - rotatably attached.
- the tongue 39 is preferably formed on the back 23 of the clamp element 20 and preferably in one piece with it, so that the guide element 32 remains stationary with respect to the back 23 when the legs 21 are opened or closed.
- the guide element 32 has a lever 40. 7 and 8 demonstrate Fig. 7 the clamp element 20 from above with the lever in the closed position and Fig. 8 the clamp element 20 with the lever 40 and the legs 21 in the open position.
- Fig. 5c shows the guide element 32 with the lever 40 attached to it in a view from below. Also in the exploded view Fig. 4 the lever 40 can be seen.
- a handle element 41 is formed on the lever 40, which is shown in particular in the perspective drawings Fig. 3 and Fig. 4 can be seen. The operation of the lever 40 is thus facilitated.
- the elongated holes have on their inside, i.e. on that longitudinal side 35, which are closer to the axis of movement - here the second axis of rotation 36 - bulges 38 in the area of the corresponding narrow sides 34, which correspond to the open state, as already described above.
- Corresponding bulges 38 can alternatively or additionally also be provided for the closed state on the other narrow side 34 and the other long side 35, with a hold being secured therein only when the clamp is under tension.
- fixing means are advantageously formed or arranged on the lever 40 and on the clamp element 20, which are preferably designed as a latching connection, by means of which the lever 40 is secured in its position at least when the legs 21 are closed.
- the latching connection here comprises a latching lug 42 arranged on the bracket element in the region of the back 23 and a latching hole 43 formed on the lever 40 and corresponding to the latching lug 42.
- eccentric elements instead of the pins 31, which are arranged eccentrically with respect to the second axis of rotation 35 on the guide element 22.
- These can be formed separately on the guide element 22 and, for example, have the shape of cylinders which are arranged, for example, in the region of those narrow sides 34 which are further away from the second axis of rotation 36.
- they can also follow the shape of the elongated holes 33 and be designed as curved, elongated elevations.
- pins 31 can also be dispensed with in the embodiment with eccentric elements, which simplifies production and makes them more cost-effective since metal parts are then no longer required for the clamping mechanism.
- Fig. 9 finally shows the trocar holder with a sterilization film 46 which is arranged between the base element 19 and the clamp element 20. This can be placed between the two before operation, before the clamp element 20 and base element 19 are put together, the sterilization film 46 is then fixed by the snap connection in the assembled state.
- the sterilization film 46 can also be non-detachably connected to the clamp element 20 if this - in combination with the receiving element 24 and the trocar 18 and the clamp mechanism - is designed as a disposable element and has been packaged sterile during manufacture.
- the above-described trocar holder enables the receiving element 24 to be changed easily and thus to be easily changed between trocars 18 of different diameters.
- the additional tilting degree of freedom for the trocar 18 reduces the load on the patient's tissue cover, so that the device guiding the trocar holder can be made more compact.
- a sterility limit is established between the clamp element 20 and the base element 19 by using a sterilization film, so that here the sterility area has a very large extension with respect to the distance from the patient, which guarantees the greatest possible safety.
- the clamp element 20, but also the base element 19 and other important parts such as the receiving element 24, guide element 32, lever 40 etc. are made of plastic, so that inexpensive production is possible and the clamp element 20 can also be designed as a disposable element, which is the Security also increased.
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Abstract
Die Erfindung betrifft eine Trokarhalterung für einen Manipulator eines robotischen Operationssystems. Eine solche Trokarhalterung umfasst ein Basiselement (19) zur Befestigung der Trokarhalterung am Manipulator und ein Klammerelement (20), welches über einen Kopplungsmechanismus mit dem Basiselement (19) auswechselbar verbunden ist. Am Klammerelement (20) sind zwei relativ zueinander in einer Klammerebene bewegliche Schenkel (21) ausgebildet. Die Schenkel (21) sind über einen Rücken (23) verbunden und weisen freie Spitzen (22) auf. Schließlich verfügt die Trokarhalterung auch über einen Klammermechanismus zum Öffnen und Schließen der Schenkel (21). The invention relates to a trocar holder for a manipulator of a robotic operating system. Such a trocar holder comprises a base element (19) for attaching the trocar holder to the manipulator and a clamp element (20) which is exchangeably connected to the base element (19) via a coupling mechanism. Two limbs (21) which are movable relative to one another in a clamp plane are formed on the clamp element (20). The legs (21) are connected via a back (23) and have free tips (22). Finally, the trocar holder also has a clamp mechanism for opening and closing the legs (21).
Description
Die Erfindung betrifft eine Trokarhalterung für einen Manipulator eines robotischen Operationssystems. Eine solche Trokarhalterung umfasst ein Basiselement zur Befestigung der Trokarhalterung am Manipulator. Außerdem umfasst sie ein Klammerelement mit zwei Schenkeln, welches über einen Kopplungsmechanismus mit dem Basiselement auswechselbar verbunden ist. Die beiden Schenkel sind relativ zueinander beweglich und über einen Rücken miteinander verbunden, sie sind mit freien Spitzen ausgebildet. Schließlich umfasst die Trokarhalterung einen Klammermechanismus zum Öffnen und Schließen der Schenkel und damit der Klammer.The invention relates to a trocar holder for a manipulator of a robotic operating system. Such a trocar holder comprises a base element for fastening the trocar holder to the manipulator. In addition, it comprises a clamp element with two legs, which is connected to the base element in an exchangeable manner via a coupling mechanism. The two legs are movable relative to each other and connected to each other by a back, they are designed with free tips. Finally, the trocar holder comprises a clamp mechanism for opening and closing the legs and thus the clamp.
Für eine steigende Anzahl minimalinvasiver Operationen insbesondere an schwer zugänglichen Stellen werden heutzutage robotische Operationssysteme verwendet. Ein solches Operationssystem umfasst in der Regel eine Anzahl von Manipulatorarmen, die an ihrem einen Ende mit einer tragenden Vorrichtung gekoppelt sind und an ihrem anderen Ende eine Instrumententrägervorrichtung aufweisen. Zusammen bilden sie einen Manipulator. Die Steuerung erfolgt über ein Bedienpult, welches sich nicht unbedingt in unmittelbarer Nähe zu den Manipulatoren befinden muss.Robotic operating systems are nowadays used for an increasing number of minimally invasive operations, particularly in places that are difficult to access. Such an operating system usually comprises a number of manipulator arms which are coupled at one end to a supporting device and have an instrument carrier device at their other end. Together they form a manipulator. It is controlled via a control panel, which does not necessarily have to be in the immediate vicinity of the manipulators.
Über das Bedienpult bedient der Operateur, d.h. der Chirurg, meist mehrere robotisch gesteuerte Arme, welche die Instrumente halten, um einzelne Schritte einer Operation durchzuführen. Über das Bedienpult oder durch entsprechende Bewegungen über einen geeigneten Koppelmechanismus, der Bewegungen der Hände des Chirurgen in Bewegungen des entsprechenden Instruments umsetzt, steuert der Chirurg die Manipulatorarme des Systems. Die Manipulatoren sind vielgliedrige Systeme, bei denen die einzelnen Glieder über Gelenke miteinander verbunden sind. Ein Teil der Glieder dient der Positionierung des Manipulators relativ zu anderen Manipulatoren desselben robotischen Systems, so dass sich die Manipulatoren nicht gegenseitig behindern.The operator, ie the surgeon, usually operates a number of robotically controlled arms via the control panel, which hold the instruments in order to carry out individual steps of an operation. The surgeon controls the manipulator arms of the system via the control panel or by appropriate movements via a suitable coupling mechanism that converts movements of the surgeon's hands into movements of the corresponding instrument. The manipulators are multi-part systems in which the individual parts are connected to each other via joints. Some of the links serve to position the manipulator relative to other manipulators of the same robotic system, so that the manipulators do not interfere with one another.
Dieser Teil der Glieder wird auch als Stellvorrichtung bezeichnet, die beschriebene Positionierung erfolgt vor der Operation und wird daher auch als Vorpositionierung bezeichnet.This part of the links is also referred to as an actuating device, the positioning described takes place before the operation and is therefore also referred to as pre-positioning.
Ein anderer Teil der Glieder dient der Positionierung und Führung des Werkzeuges am Objekt, also beispielsweise der Positionierung eines Operationsinstruments oder eines Endoskops im Bereich einer Öffnung in der Gewebedecke eines Patienten. Dieser Teil der Glieder wird auch als Instrumententrägervorrichtung bezeichnet. Die Glieder eines Manipulators sind im kinematischen Sinne als offene kinematische Kette miteinander verbunden, da am letzten Glied kein weiteres Gelenk sitzt, sondern das Werkzeug. Alle anderen Glieder sind nach Art einer Kette über Gelenke miteinander verbunden.Another part of the links is used for positioning and guiding the tool on the object, for example for positioning a surgical instrument or an endoscope in the region of an opening in the tissue cover of a patient. This part of the links is also referred to as an instrument carrier device. The links of a manipulator are connected in the kinematic sense as an open kinematic chain, since there is no other joint on the last link, but the tool. All other links are connected to each other like a chain via joints.
Zur Durchführung minimalinvasiver Eingriffe werden sogenannte Trokare gesetzt, dabei handelt es sich um medizinische Instrumente, mit denen zunächst ein Zugang in den Körper geschaffen wird, beispielsweise in den Bauchraum. Dieser Zugang wird dann mittels des Trokars, der die Form eines Tubus aufweist, offengehalten. Der Tubus dient zur Einführung von chirurgischen Instrumenten in den Körper, aber auch von endoskopischen Kameras. Während der Operation sollte der Trokar seine Position nicht verändern, d.h. stabil in einer vorgegebenen Position angeordnet bleiben, es sei denn, es ist etwas anderes gefordert.So-called trocars are used to carry out minimally invasive interventions, which are medical instruments that are used to initially access the body, for example the abdominal cavity. This access is then kept open by means of the trocar, which has the shape of a tube. The tube is used to introduce surgical instruments into the body, but also from endoscopic cameras. The trocar should not change its position during the operation, i.e. remain stable in a predetermined position unless otherwise required.
Auch bei robotischen Operationssystemen werden Trokare gesetzt und während der Operation in Position gehalten. Die Instrumententrägervorrichtungen sind dafür in der Regel mit einer Trokarhalterung ausgestattet, durch welche das Instrument dann in den Körper geführt werden kann. Nach einer Vorpositionierung der Trokarhalterungen an den verschiedenen Manipulatoren des robotischen Operationssystems können die Trokare und anschließend die Instrumente eingeführt werden. Dabei ist darauf zu achten, dass die Belastung des Gewebes an den Stellen, wo die Trokare eingeführt werden, möglichst geringgehalten wird. Darüber hinaus ist der Bereich der Trokarhalterungen und der Trokare steril zu halten. Trokare können als Einweg- oder Mehrwegkomponenten ausgestaltet sein, gleiches gilt für die Trokarhalterungen. Wichtig ist, dass die Trokarhalterungen ebenfalls gewechselt werden können, um beispielsweise eine neue Operation vorzubereiten oder einen anderen Trokar anzusetzen.Trocars are also placed in robotic operating systems and held in position during the operation. For this purpose, the instrument carrier devices are usually equipped with a trocar holder, through which the instrument can then be guided into the body. After the trocar holders have been pre-positioned on the various manipulators of the robotic operating system, the trocars and then the instruments can be inserted. It is important to ensure that the load on the tissue where the trocars are inserted is kept as low as possible. In addition, the area of the trocar holders and trocars must be kept sterile. Trocars can be designed as single-use or reusable components, the same applies to the trocar holders. It is important that the trocar holders can also be changed, for example to prepare a new operation or to set up another trocar.
Üblicherweise erfolgt die Befestigung des Klammerelements über das Basiselement am Manipulator in der Weise, dass eine Relativbewegung zwischen beiden im montierten bzw. verbundenen Zustand ausgeschlossen ist, da über das Basiselement gegebenenfalls auch ein elektrischer Kontrakt mit einer Instrumentenführung bzw. mit dem Manipulator hergestellt wird, der beispielsweise ein elektrisches Öffnen und Schließen der Klammer erlaubt. In diesem Fall wird zur Einhaltung des Gebots der Verwendung steriler Instrumente eine diese Bedingung sichernde Sterilisationsfolie oder ein ähnliches Mittel in die Klammer, die dann den Trokar hält, eingelegt. Da die Trokarhalterung selbst nicht steril ist und dennoch in relativ großer Nähe zum Patienten geführt wird, besteht hier in manchen Fällen ein erhöhtes Infektionsrisiko.Usually, the clamp element is attached to the manipulator via the base element in such a way that a relative movement between the two in the assembled or connected state is excluded, since the base element may also be used to produce an electrical contract with an instrument guide or with the manipulator, which for example, an electrical opening and closing of the clip allowed. In this case, in order to comply with the requirement for the use of sterile instruments, a sterilization film or a similar means which ensures this condition is inserted into the clamp, which then holds the trocar. Since the Trocar holder itself is not sterile and is nevertheless kept relatively close to the patient, so there is an increased risk of infection in some cases.
Im Zusammenhang mit robotischen Operationssystemen sind im Stand der Technik verschiedene Trokarhalterungen, mit denen allgemein der Trokar relativ zu einem Patienten positioniert werden kann, bekannt.In connection with robotic operating systems, various trocar holders with which the trocar can generally be positioned relative to a patient are known in the prior art.
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Aufgabe der Erfindung ist es eine Trokarhalterung für ein robotisches Operationssystem der eingangs beschriebenen Art dahingehend weiterzuentwickeln, dass zum einen eine leichte Auswechselbarkeit gegeben ist, eine Anpassung an verschiedene Durchmesser von Trokaren auf einfachere Weise realisiert werden kann, wobei für alle Durchmesser ein gleichermaßen sicherer Halt gewährleistet werden soll, und dabei außerdem die Belastung des Patienten so gering wie möglich zu halten.The object of the invention is to further develop a trocar holder for a robotic operating system of the type described at the outset in such a way that, on the one hand, there is an easy interchangeability, and adaptation to different diameters of trocars can be implemented in a simpler manner, with an equally secure hold being ensured for all diameters should be kept as low as possible.
Erfindungsgemäß wird diese Aufgabe bei einer Trokarhalterung der eingangs beschriebenen Art dadurch gelöst, dass die Trokarhalterung ein Aufnahmeelement für einen Trokar umfasst.According to the invention, this object is achieved in the case of a trocar holder of the type described in the introduction in that the trocar holder comprises a receiving element for a trocar.
Mit dem Klammermechanismus werden die Schenkel geöffnet und geschlossen, bei geöffneten Schenkeln lässt sich der Trokar samt Aufnahmeelement entfernen und beispielsweise austauschen. Auf diese Weise können Aufnahmeelemente für verschiedene Trokare ohne besonderen Aufwand gewechselt werden, beispielsweise kann ein Aufnahmeelement für einen Trokar, der ein Skalpell aufnehmen soll, gegen einen dickeren für ein Endoskop ausgetauscht werden. Da die Aufnahmeelemente an die diversen Trokare optimal angepasst werden können, ist immer der bestmögliche Halt gegeben. Die Aufnahmeelemente können insbesondere auch mit den Trokaren fest verbunden sein, indem sie beispielsweise einstückig, bevorzugt aus Kunststoff, gefertigt sind.With the clamp mechanism, the legs are opened and closed; when the legs are open, the trocar and the receiving element can be removed and replaced, for example. In this way, receptacle elements for different trocars can be exchanged without special effort, for example, a receptacle element for a trocar that is intended to hold a scalpel can be exchanged for a thicker one for an endoscope. Since the receiving elements can be optimally adapted to the various trocars, the best possible hold is always given. The receiving elements can in particular also be firmly connected to the trocars, for example by being made in one piece, preferably from plastic.
Bevorzugt wird das Aufnahmeelement bei geschlossenen Schenkeln von diesen um eine in der Klammerebene liegende erste Rotationsachse rotierbar gehalten. Auf diese Weise wird ein Freiheitsgrad für die Trokarhalterung derart realisiert, dass diese um einen Pivotpunkt auf Ihrer Längsachse schwenkbar ist, wodurch ein kompakterer Aufbau ermöglicht sowie eine Reduzierung der Gewebebelastung des Patienten bei eingesetztem Trokar erreicht wird.When the legs are closed, the receiving element is preferably held rotatably about a first axis of rotation lying in the plane of the clamp. In this way, a degree of freedom for the trocar holder is realized in such a way that it can be pivoted about a pivot point on its longitudinal axis, which enables a more compact structure and a reduction in the tissue load on the patient when the trocar is inserted.
In einer bevorzugten Ausgestaltung ist im Bereich der Spitzen jedes der beiden Schenkel ein sogenanntes Radiaxlager ausgebildet, d.h. ein Lager, welches für eine Welle oder Achse sowohl eine Radialbewegung verhindert, als auch eine axiale Bewegung in einer Richtung entlang der Achse, beispielsweise mit Hilfe eines Anschlags. Durch die Verwendung von zwei Radiaxlagern lässt sich die axiale Bewegung in beiden Richtungen entlang der Achse beschränken. Das Aufnahmeelement selbst ist in diesem Fall als Achse ausgebildet und wird von den beiden Radiaxlagern eingespannt, so dass das Aufnahmeelement bei geschlossenen Schenkeln von den Radiaxlagern an einer axialen Bewegung gehindert ist. Zur Durchführung des Trokars weist das Aufnahmeelement eine durchgehende Öffnung senkrecht durch die Achse auf. Bei der Öffnung kann es sich um eine einfache ringförmige Öffnung handeln, deren Innendurchmesser etwa dem Außendurchmesser des Trokars entspricht. Je nach Durchmessers des Trokars können verschiedene Aufnahmeelemente zum Einsatz können, die verschiedenen Durchmesser aufweisen. Auf diese Weise ist stets ein optimaler Halt des Trokars in dem Aufnahmeelement und damit in der Trokarhalterung gegeben, da mittels verschiedener Aufnahmeelemente eine Anpassung auf verschiedene Durchmesser exakt und ohne besonderen Aufwand realisiert werden kann. Dies erhöht die Sicherheit in der Handhabung des Operationssystems.In a preferred embodiment, a so-called radial bearing is formed in the region of the tips of each of the two legs, that is to say a bearing which prevents radial movement for a shaft or axis, as well as axial movement in one direction along the axis, for example with the aid of a stop , By using two radiax bearings the axial movement can be restricted in both directions along the axis. The receiving element itself is in this case designed as an axis and is clamped by the two radial bearings, so that the receiving element is prevented from axial movement by the radial bearings when the legs are closed. To carry out the trocar, the receiving element has a continuous opening perpendicular to the axis. The opening can be a simple annular opening, the inside diameter of which corresponds approximately to the outside diameter of the trocar. Depending on the diameter of the trocar, different receiving elements can be used which have different diameters. In this way, the trocar is always optimally held in the receiving element and thus in the trocar holder, since an adaptation to different diameters can be implemented precisely and without special effort by means of different receiving elements. This increases safety in the handling of the operating system.
Übliche Trokare für robotische Operationssysteme verfügen über eine Instrumentenaufnahme mit einem eher großen Durchmesser und ein sich daran anschließendes Durchführungselement mit einem gegenüber der Instrumentenaufnahme kleineren Durchmesser; das Durchführungselement ist in der Regel als zylinderförmiger Tubus ausgestaltet. Das Instrument wird mindestens von der Instrumentenaufnahme daher an einem Durchrutschen gehindert, es wird darin gelagert und ggf. auch fixiert. Werden im Zusammenhang mit der Erfindung speziell angepasste Trokare verwendet, deren Tubus nicht zylinderförmig ausgebildet ist, sondern bei denen das Durchführungselement die Form eines Kegelstumpfes aufweist, der sich von der Instrumentenaufnahme abstehend - also von der Instrumentenaufnahme weg - verjüngt, wobei der Kegelwinkel äußerst schmal gewählt wird, so dass ein Unterschied zur Zylinderform mit bloßem Auge kaum erkennbar ist, so kann mittels des Durchmessers der durchgehenden Öffnung im Aufnahmeelement die Eindringtiefe des Trokars in begrenztem Umfang kontrolliert und zumindest begrenzt werden.Conventional trocars for robotic operating systems have an instrument holder with a rather large diameter and an adjoining lead-through element with a smaller diameter than the instrument holder; the lead-through element is usually designed as a cylindrical tube. The instrument is therefore at least prevented from slipping by the instrument holder, it is stored therein and, if necessary, also fixed. Are used in connection with the invention specially adapted trocars, the tube is not cylindrical, but in which the lead-through element has the shape of a truncated cone that tapers away from the instrument holder - that is, away from the instrument holder - with the cone angle chosen to be extremely narrow becomes so that a difference to the cylindrical shape is barely visible to the naked eye, the penetration depth of the trocar can be controlled to a limited extent and at least limited by means of the diameter of the through opening in the receiving element.
Der Kopplungsmechanismus für die Verbindung zwischen Basiselement und Klammerelement ist bevorzugt als Schnellverschluss ausgestaltet, der mit der Hand ohne weitere Hilfsmittel bedienbar ist. Beispielsweise eignet sich besonders gut eine Schnappverbindung. Das Basiselement wird dann fest am Manipulator montiert und das Klammerelement mittels der Schnappverbindung am Basiselement fixiert, eine Relativbewegung zwischen Basiselement und Klammerelement ist dann ausgeschlossen. Das Klammerelement selbst ist dann mechanisch, d.h. per Hand zu bedienen. Eine sterile Trennung zwischen dem Klammerelement und dem Basiselement kann erreicht werden, indem vor der Herstellung der Verbindung zwischen den beiden Elementen eine Sterilisationsfolie zwischen beide eingebracht wird. Diese kann beispielsweise zwischen den beiden Elementen geklemmt gehalten werden oder mit dem Klammerelement lösbar oder fest verbunden sein. Der Sterilitätsbereich kann dadurch letzten Endes gegenüber dem Stand der Technik weiter vom Patienten weggelegt werden, was die hygienische Sicherheit verbessert. Dafür müssen alle Teile auf der dem Patienten zugewandten Seite der Sterilisationsfolie steril ausgelegt sein, was mindestens das Aufnahmeelement, das Klammerelement und den Klammermechanismus umfasst; selbstverständlich auch den Trokar.The coupling mechanism for the connection between the base element and the clamp element is preferably designed as a quick-release fastener, which can be operated by hand without further aids. For example, a snap connection is particularly suitable. The base element is then firmly mounted on the manipulator and the clip element is fixed to the base element by means of the snap connection, a relative movement between the base element and the clip element is then excluded. The clamp element itself can then be operated mechanically, ie by hand. A sterile separation between the clamp element and the base element can be achieved by inserting a sterilization film between the two before the connection between the two elements is established. This can, for example, be held clamped between the two elements or be detachably or firmly connected to the clamp element. In the end, the sterility area can be further removed from the patient compared to the prior art, which improves the hygienic safety. Therefore all parts on the side of the sterilization film facing the patient must be sterile, which includes at least the receiving element, the clamping element and the clamping mechanism; of course also the trocar.
In einer besonders bevorzugten Ausgestaltung sind mindestens das Aufnahmeelement, das Klammerelement und das Basiselement aus Kunststoff gefertigt. Die Ausbildung aus Kunststoff ermöglicht es, die Kosten bei der Herstellung zu reduzieren und zumindest das Klammerelement und das Aufnahmeelement auch als Einwegteile, d.h. für den einmaligen Gebrauch, vorzusehen, was die hygienischen Bedingungen weiter verbessert.In a particularly preferred embodiment, at least the receiving element, the clamp element and the base element are made of plastic. The design made of plastic makes it possible to reduce the production costs and at least the clip element and the receiving element also as disposable parts, i.e. for single use, to be provided, which further improves the hygienic conditions.
Die beiden Schenkel und der Rücken des Klammerelements sind besonders bevorzugt einstückig ausgebildet. Insbesondere bei der einstückigen Fertigung von Schenkeln und Rücken, aber auch bei anderen Arten der Verbindung, beispielsweise einer Schraub- oder Klebeverbindung weist die aus Schenkeln und Rücken gebildete Klammer vorteilhaft eine Federwirkung auf, die dazu führt, dass die Schenkel bei elastischer Auslenkung aus einer Ruheposition, einer Nullstellung bei der keine Rückstellkraft wirkt, elastisch in diese zurückfedern, sofern die zur Auslenkung nötige Krafteinwirkung nachlässt bzw. sie nicht mehr in ihrer ausgelenkten Position gehalten werden. Mindestens einer der Schenkel ist daher vorteilhaft federnd mit dem Rücken verbunden. Die elastische Auslenkung aus der Nullstellung erfolgt mittels Krafteinwirkung, die beispielsweise durch den Klammermechanismus ausgeübt werden kann.The two legs and the back of the clamp element are particularly preferably formed in one piece. In particular in the one-piece production of legs and back, but also in other types of connection, for example a screw or adhesive connection, the clip formed from legs and back advantageously has a spring action, which leads to the legs being deflected from a rest position with elastic deflection , a zero position at which there is no restoring force, spring back elastically into it, provided the force required for the deflection subsides or they are no longer held in their deflected position. At least one of the legs is therefore advantageously connected to the back in a resilient manner. The elastic deflection from the zero position takes place by means of force, which can be exerted, for example, by the clamp mechanism.
Der Klammermechanismus kann auf verschiedenen Weise realisiert werden, wobei darauf geachtet werden muss, dass das Aufnahmeelement mit dem Trokar sicher gehalten wird und vor unbeabsichtigtem Lösen geschützt ist. In einer zweckmäßigen Ausgestaltung umfasst der Klammermechanismus mindestens einen Stift, der in einem von Null verschiedenen Winkel zur Klammerebene im betreffenden Schenkel fixiert ist. Außerdem umfasst der Klammermechanismus dann ein entlang einer oder um eine Bewegungsachse relativ zum Klammerelement bewegliches Führungselement, in welches mindestens ein Langloch mit Schmalseiten und Längsseiten eingebracht ist. Die Anzahl der Langlöcher korrespondiert dabei zur Anzahl der Stifte, wobei in jedem der Schenkel ein Stift vorgesehen sein kann. Der mindestens eine Stift, der vorzugsweise aus Metall gefertigt ist, insbesondere Edelstahl, wird in dem mindestens einen Langloch geführt, wobei die beiden Schmalseiten des mindestens einen Langlochs in verschiedenen Abständen zur Bewegungsachse liegen, so dass sich der mindestens eine Schenkel - entsprechend der Anzahl der Stifte - bei Bewegung des Führungselements entlang der oder um die Bewegungsachse öffnet oder schließt. Bevorzugt werden zwei Stifte verwendet, d.h. in jedem der beiden Schenkel ist je ein Stift fixiert, vorzugsweise senkrecht zur Klammerebene. Dies erhöht die Stabilität und verbessert die Handhabung.The clamp mechanism can be implemented in various ways, taking care that the receiving element is held securely with the trocar and is protected against unintentional loosening. In an expedient embodiment, the clamp mechanism comprises at least one pin which is fixed in the leg in question at an angle to the clamp plane which is different from zero. In addition, the clamp mechanism then comprises a guide element which can be moved along or about a movement axis relative to the clamp element and into which at least one elongated hole with narrow sides and long sides is made. The number of elongated holes corresponds to the number of pins, and a pin can be provided in each of the legs. The at least one pin, which is preferably made of metal, in particular stainless steel, is guided in the at least one elongated hole, the two narrow sides of the at least one elongated hole being at different distances from the axis of movement, so that the at least one leg - corresponding to the number of Pins - opens or closes when the guide element moves along or around the movement axis. Two pins are preferably used, ie one pin is fixed in each of the two legs, preferably perpendicular to the plane of the clamp. This increases stability and improves handling.
Durch die Bewegung des Führungselements erfolgt eine Relativbewegung zwischen Stift und Langloch, die durch die Schmalseiten des Langlochs beschränkt wird. Befindet sich der Stift an der näher zur Bewegungsachse liegenden Schmalseite, so ist die Klammer bzw. der betreffende Schenkel geschlossen. Befindet sich der Stift an der anderen Schmalseite des Langlochs, so ist die Klammer bzw. der Schenkel geöffnet.The movement of the guide element results in a relative movement between the pin and the elongated hole, which is limited by the narrow sides of the elongated hole. If the pin is located on the narrow side closer to the axis of movement, the clamp or the relevant leg is closed. If the pin is on the other narrow side of the elongated hole, the clip or leg is open.
Der Klammermechanismus kann dann auf verschiedene Arten realisiert werden. In einer möglichen Ausgestaltung liegt die Bewegungsachse in der Klammerebene und ist von beiden - in der Regel symmetrischen - Schenkeln gleich beabstandet, liegt also genau in der Mitte zwischen beiden. Das Führungselement ist in diesem Fall als Führungsschlitten ausgebildet, welcher entlang der Bewegungsachse verschiebbar ist. Das mindestens eine Langloch kann gerade ausgeführt werden, um eine in Bezug auf die Verschiebung, d.h. die zurückgelegte Strecke, lineare Öffnung bzw. Schließung der Klammer zu erreichen. Andere, gekrümmte Langlöcher sind möglich, um beispielsweise den Kraftaufwand bei zunehmender Öffnung zu verringern, was bedeutet, dass bei zunehmender Öffnung die Verschiebestrecke des Schlittens für einen vorgegebenen Winkel größer wird, da die Krümmung verringert wird.The clamp mechanism can then be implemented in different ways. In one possible embodiment, the axis of movement lies in the plane of the brackets and is equally spaced from both - generally symmetrical - legs, that is, it lies exactly in the middle between the two. In this case, the guide element is designed as a guide slide which can be displaced along the movement axis. The at least one elongated hole can be made straight to be one with respect to the displacement, i.e. to achieve the distance covered, linear opening or closing of the bracket. Other curved elongated holes are possible, for example in order to reduce the force required when the opening increases, which means that the sliding distance of the slide increases for a predetermined angle as the opening increases, since the curvature is reduced.
Noch kompakter lässt sich der Klammermechanismus gestalten, wenn die Bewegungsachse als zweite Rotationsachse ausgebildet ist, welche mit der Klammerebene einen von Null verschiedenen Winkel, bevorzugt einen rechten Winkel einschließt. Das Führungselement ist in diesem Fall um die zweite Rotationsachse drehbar, wobei das mindestens eine Langloch -welches auch als Kulisse bezeichnet wird - mindestens teilweise gekrümmt ist. Die zweite Rotationsachse verläuft dabei bevorzugt durch das Führungselement.The clamp mechanism can be made even more compact if the movement axis is designed as a second axis of rotation, which includes an angle other than zero, preferably a right angle, with the clamp plane. In this case, the guide element can be rotated about the second axis of rotation, the at least one elongated hole — which is also referred to as the backdrop — being at least partially curved. The second axis of rotation preferably runs through the guide element.
Durch Drehung des Führungselements um die zweite Rotationsachse werden - bei der beispielhaften, aber nicht beschränkenden Verwendung zweier Stifte - die Stifte in den beiden Langlöchern zwischen den Endpositionen, d.h. den Schmalseiten der Langlöcher hin und her bewegt, je nach Rotationsrichtung. Diejenigen Schmalseiten der Langlöcher, die den kürzesten radialen Abstand zur zweiten Rotationsachse haben, definieren dann den Zustand einer geschlossenen Klammer bzw. geschlossener Schenkel, hier sind die Stifte der zweiten Rotationsachse des Führungselements am nächsten. Die anderen Schmalseiten, die von der zweiten Rotationsachse am weitesten entfernt liegen, definieren dann die Position der geöffneten Klammer bzw. geöffneter Schenkel. Dabei ist es nicht zwingend notwendig, dass beide Stifte jeweils die Endpositionen, d.h. die Schmalseiten auch tatsächlich erreichen, wesentlich ist, dass die Bewegung des Führungselements in einer Relativbewegung der beiden Schenkel aufeinander zu bzw. voneinander weg resultiert, wenn die Bewegungsrichtung umgekehrt wird.By rotating the guide element about the second axis of rotation - in the exemplary but non-limiting use of two pins - the pins in the two elongated holes are moved back and forth between the end positions, ie the narrow sides of the elongated holes, depending on the direction of rotation. Those narrow sides of the elongated holes which have the shortest radial distance from the second axis of rotation then define the state of a closed bracket or closed leg, the pins being closest to the second axis of rotation of the guide element. The other narrow sides, which are furthest away from the second axis of rotation, then define the position of the opened clamp or open leg. It is not absolutely necessary that both pins each reach the end positions, ie actually reach the narrow sides, that the movement of the guide element results in a relative movement of the two legs towards or away from each other if the direction of movement is reversed.
Dabei reicht es prinzipiell aus, wenn nur ein Schenkel mit einem Stift versehen ist und das Führungselement ein einziges Langloch aufweist, in welchem der Stift geführt wird. Bereits auf diese Weise lässt sich die Klammer öffnen und schließen, indem der eine Schenkel in der Klammerebene von dem anderen weg bzw. auf diesen zu bewegt wird.In principle, it is sufficient if only one leg is provided with a pin and the guide element has a single elongated hole in which the pin is guided. The clamp can already be opened and closed in this way by moving one leg in the clamp plane away from or towards the other.
Vorteilhaft ist es jedoch, zwei Langlöcher mit zwei Stiften vorzusehen, dies ermöglicht zum einen die Klammer weiter zu öffnen, wenn die Abstände der Schmalseiten der Langlöcher in Bezug auf die Bewegungsachse gleich bleiben, im Vergleich der Verwendung nur eines Langlochs. Zum anderen wird dadurch die Stabilität des Systems erhöht und die Handhabung erleichtert, da zur Erzielung des gleichen Abstandes der Spitzen der Schenkel im Vergleich zur Bewegung nur eines Schenkels die Auslenkung der beiden Schenkel geringer ausfällt, so dass der Kraftaufwand verringert werden kann und die Materialermüdung durch die elastische Verformung beim Aufbiegen reduziert wird.However, it is advantageous to provide two elongated holes with two pins, on the one hand this enables the clip to be opened further if the distances between the narrow sides of the elongated holes with respect to the axis of movement remain the same compared to the use of only one elongated hole. On the other hand, this increases the stability of the system and simplifies handling, since to achieve the same distance between the tips of the legs compared to the movement of only one leg, the deflection of the two legs is less, so that the effort required and the material fatigue can be reduced the elastic deformation during bending is reduced.
Zweckmäßig und besonders einfach zu bedienen ist dabei ein Klammermechanismus, bei dem die Stifte - und für den Fall, dass die Bewegungsachse auch als Rotationsachse ausgebildet ist, auch die Rotationsachse - senkrecht zur Klammerebene angeordnet sind.A clamp mechanism is expedient and particularly easy to use, in which the pins - and in the event that the axis of movement is also designed as an axis of rotation, the axis of rotation - are arranged perpendicular to the plane of the clamp.
Um zu vermeiden, dass sich der Klammermechanismus unwillkürlich öffnet oder schließt, wenn der Trokar beispielsweise bewegt wird, kann der mindestens eine Stift in Bezug auf das mindestens eine Langloch eine Übermaßpassung aufweisen, die so bemessen ist, dass eine mechanische Verschiebung unter geringem Krafteinsatz ohne Anstrengung eines Bedieners dennoch möglich bleibt.In order to avoid that the clamp mechanism opens or closes involuntarily when the trocar is moved, for example, the at least one pin can have an interference fit with respect to the at least one elongated hole, which is dimensioned such that mechanical displacement with little effort without effort of an operator still remains possible.
In dem Falle, dass die Bewegungsachse eine zweite Rotationsachse ist, um die das Führungselement rotierbar ist, lässt sich letzteres besonders vorteilhaft auf einer mit dem Klammerelement verbundenen Zunge, die besonders zweckmäßig am Rücken des Klammerelements befestigt ist, rotierbar befestigen. Die Zunge kann einstückig mit dem Rücken ausgebildet sein. Das rotierbare Führungselement hat gegenüber dem verschiebbaren den Vorteil, dass es immer im gleichen Bereich des Klammerelements angeordnet ist, wodurch eine kompakte Anordnung und eben auch die Befestigung am Klammerelement selbst auf einfache, kompakte Weise möglich ist, diese Befestigung fixiert die zweite Rotationsachse zusätzlich und stabilisiert die Vorrichtung weiter.In the event that the axis of movement is a second axis of rotation about which the guide element can be rotated, the latter can particularly advantageously be rotatably attached to a tongue connected to the clamp element, which is particularly expediently fastened to the back of the clamp element. The tongue can be formed in one piece with the back. The rotatable guide element has the advantage over the displaceable one that it is always arranged in the same area of the clamp element, whereby a compact arrangement and also the attachment to the clamp element itself is possible in a simple, compact manner, this fixation additionally fixes and stabilizes the second axis of rotation the device further.
In einer weiteren bevorzugten Ausgestaltung weist das mindestens eine Langloch im Führungselement im Bereich der weiter von der Bewegungsachse entfernt liegenden Schmalseite an derjenigen Längsseite, die der Bewegungsachse zugewandt ist, eine Ausbuchtung in Richtung der Bewegungsachse auf, in welche der mindestens eine Stift bei geöffneten Schenkeln einrastet.In a further preferred embodiment, the at least one elongated hole in the guide element in the region of the narrow side which is further away from the axis of movement on the longitudinal side which faces the axis of movement has a bulge in the direction of the axis of movement into which the at least one pin engages when the legs are open ,
Dies ist dann besonders sinnvoll, wenn Rücken und Schenkel einstückig gefertigt sind und aufgrund der elastischen Biegung beim Öffnen der Schenkel die Stifte aufgrund der Rückstellkraft in die Ausbuchtungen gedrückt werden. Die geöffnete Stellung wird damit besser fixiert und die Handhabung beim Wechsel von Aufnahmeelementen sicherer.This is particularly useful if the back and legs are made in one piece and the pins are pressed into the bulges due to the restoring force due to the elastic bend when the legs are opened. The open position is thus better fixed and the handling when changing the receiving elements safer.
Zweckmäßig weist das Führungselement dabei, insbesondere wenn die Bewegungsachse als zweite Rotationsachse ausgebildet ist, einen Hebel zum Betätigen des Klammermechanismus auf. Der Hebel greift dann an der einen Seite an die Rotationsachse an und erstreckt sich in im Wesentlichen radialer Richtung von ihr weg. Beim Betätigen des Hebels wird also das Führungselement um die Rotationsachse gedreht.The guide element expediently has a lever for actuating the clamp mechanism, in particular if the movement axis is designed as a second axis of rotation. The lever then engages on one side with the axis of rotation and extends away from it in a substantially radial direction. When the lever is actuated, the guide element is rotated about the axis of rotation.
Bevorzugt sind dabei am Hebel und am Klammerelement einander entsprechende, d.h. zueinander korrespondierende Fixierungsmittel ausgebildet, beispielsweise als Rastverbindung, mittels welcher der Hebel mindestens bei geschlossenen Schenkel in seiner Position gesichert ist. Dies erschwert zusätzlich die Möglichkeit des unwillkürlichen Öffnens, sichert die Trokarhalterung aber auch gegen unbeabsichtigtes Öffnen bei zufälliger Berührung.Preferably, on the lever and on the clamp element, corresponding, i.e. Fixing means corresponding to one another are formed, for example as a latching connection, by means of which the lever is secured in its position at least when the leg is closed. This further complicates the possibility of involuntary opening, but also secures the trocar holder against unintentional opening when accidentally touched.
Vorzugsweise befindet sich der Hebel dann in einer projizierten Draufsicht auf die Klammerebene innerhalb der Kontur des Klammerelements oder schließt mit diesem bündig ab, was ebenfalls eine zusätzliche Sicherung gegen unbeabsichtigtes Öffnen darstellt.The lever is then preferably located in a projected plan view of the clamp plane within the contour of the clamp element or is flush with it, which also represents an additional safeguard against unintentional opening.
In einer weiteren Ausgestaltung ist das Aufnahmeelement fest mit einem Trokar (18) verbunden und bevorzugt einstückig mit diesem gefertigt. Damit kann ein versehentliches Herausrutschen des Trokars aus dem Aufnahmeelement verhindert werden.In a further embodiment, the receiving element is firmly connected to a trocar (18) and is preferably manufactured in one piece with it. This can prevent the trocar from accidentally slipping out of the receiving element.
Eine Abwandlung des Klammermechanismus mit einem um die zweite, mit der Klammerebene einen von Null verschiedenen Winkel einschließende Rotationsachse drehbaren Führungselement ergibt sich, wenn anstelle von Stiften an dem Führungselement mindestens ein bezüglich der zweiten Rotationsachse exzentrisch angeordnetes Exzenterelement angebracht ist, so dass sich bei einer Drehung des Führungselements um die zweite Rotationsachse mindestens einer der Schenkel durch die Wirkung des Exzenterelements öffnet bzw. schließt. Das Exzenterelement kann dabei gesondert auf dem - bevorzugt scheibenförmig ausgebildeten - Führungselement angeordnet oder ausgebildet sein, es kann aber auch Teil des Hebelgriffs sein, indem dieser in dem Bereich, in welchem er mit dem Führungselement verbunden ist, eine entsprechend variierende Krümmung aufweist. Im geschlossenen Zustand steht das mindestens eine Exzenterelement dann nicht in Kontakt mit dem entsprechenden Schenkel oder liegt an diesem nur an, so dass der Schenkel nicht unter Vorspannung steht. Durch Drehung des Führungselements wird das Exzenterelement dann in den Bereich des Schenkels geführt und drückt diesen in der Klammerebene von der zweiten Rotationsachse weg. Vorzugsweise werden auch hier zwei Exzenterelemente verwendet, die jedoch einstückig mit dem Hebel ausgebildet sein können.A modification of the clamp mechanism with a guide element rotatable about the second axis of rotation including an angle different from the clamp plane results if, instead of pins, at least one eccentric element arranged eccentrically with respect to the second axis of rotation is attached to the guide element, so that during rotation of the guide element about the second axis of rotation at least one of the legs opens or closes by the action of the eccentric element. The eccentric element can be arranged or formed separately on the - preferably disc-shaped - guide element, but it can also be part of the lever handle in that it has a correspondingly varying curvature in the region in which it is connected to the guide element. In the closed state, the at least one eccentric element is then not in contact with the corresponding leg or is only in contact with it, so that the leg is not under prestress. By rotating the guide element the eccentric element is then guided into the region of the leg and presses it away from the second axis of rotation in the plane of the clamp. Preferably, two eccentric elements are also used here, which, however, can be formed in one piece with the lever.
Es versteht sich, dass die vorstehend genannten und die nachstehend noch zu erläuternden Merkmale nicht nur in den angegebenen Kombinationen, sondern auch in anderen Kombinationen oder in Alleinstellung einsetzbar sind, ohne den Rahmen der vorliegenden Erfindung zu verlassen.It goes without saying that the features mentioned above and those yet to be explained below can be used not only in the specified combinations but also in other combinations or on their own without departing from the scope of the present invention.
Nachfolgend wird die Erfindung beispielsweise anhand der beigefügten Zeichnungen, die auch erfindungswesentliche Merkmale offenbaren, noch näher erläutert. Es zeigen:
- Fig. 1a), b)
- die Gesamtansicht eines robotischen Operationssystems,
- Fig. 2
- eine Instrumententrägervorrichtung mit einer Trokarhalterung und Trokar in Perspektivansicht,
- Fig. 3
- eine Trokarhalterung mit Trokar in Perspektivansicht,
- Fig. 4
- eine Explosionszeichnung der Trokarhalterung mit Trokar,
- Fig. 5a)
- ein Klammerelement der Trokarhalterung von unten,
- Fig. 5b)
- ein Aufnahmeelement der Trokarhalterung von unten,
- Fig. 5c)
- ein Führungselement der Trokarhalterung von unten,
- Fig. 6a), b)
- die Trokarhalterung im geschlossenen Zustand von oben bzw. unten,
- Fig. 7
- das Klammerelement mit einem eingesetzten Aufnahmeelement im geschlossenen Zustand,
- Fig. 8
- das Klammerelement mit daraus entferntem Aufnahmeelement im geöffneten Zustand, und
- Fig. 9
- eine Trokarhalterung mit Trokar und Sterilisationsfolie.
- 1a), b)
- the overall view of a robotic operating system,
- Fig. 2
- an instrument carrier device with a trocar holder and trocar in perspective view,
- Fig. 3
- a trocar holder with trocar in perspective view,
- Fig. 4
- an exploded view of the trocar holder with trocar,
- 5a)
- a clamp element of the trocar holder from below,
- 5b)
- a receiving element of the trocar holder from below,
- 5c)
- a guide element of the trocar holder from below,
- 6a), b)
- the trocar holder when closed from above or below,
- Fig. 7
- the clamp element with an inserted receiving element in the closed state,
- Fig. 8
- the clip element with the receiving element removed therefrom in the open state, and
- Fig. 9
- a trocar holder with trocar and sterilization film.
Das robotische Operationssystem verfügt auch über eine Steuervorrichtung 10, die in
Bei dem Manipulator 5 handelt es sich um ein vielgliedriges System, welches einer losen kinematischen Kette entspricht. Ein Teil der Glieder bildet eine Positionierungsvorrichtung - auch als Manipulatorarm bezeichnet - und der übrige Teil der Glieder eine Instrumententrägervorrichtung, der Instrumentenhalter 6 ist an letzterer montiert.The
Der Kopplungsmechanismus zur Verbindung des Basiselements 19 mit dem Klammerelement 20 ist mit der Hand ohne weitere Hilfsmittel bedienbar und als Schnellverschluss, hier als Schnappverbindung ausgebildet. Am Klammerelement 20 befindet sich dazu ein Schnappelement 25, an welchem eine oder mehrere Schnappnasen 26 ausgebildet sind. Am Basiselement 19 befindet sich eine - hier nicht dargestellte - Öffnung, in welche das Schnappelement 25 eingesetzt wird und entsprechend einrastet. Zum schnellen Lösen der Rastverbindung befinden sich am Basiselement 19 zwei mechanischen Drucktasten 27, die zum Lösen der Schnappverbindung zusammengedrückt werden. Dies kann mit einer Hand erfolgen, die andere Hand kann das Klammerelement 20 halten. Vor dem Betrieb wird, bevor Klammerelement 20 und Basiselement 19 zusammengesetzt werden, zwischen beiden eine Sterilisationsfolie gelegt, die von der Schnappverbindung im zusammengesetzten Zustand fixiert wird.The coupling mechanism for connecting the
Die beiden Schenkel 21 sind relativ zueinander in einer Klammerebene beweglich. Die Klammerebene ist jene Ebene, in der die beiden Schenkel liegen und in der auch mittels des Klammermechanismus die Relativbewegung der Schenkel erzeugt wird. Mindestens einer der beiden Schenkel wird also bei Betätigung des Klammermechanismus bewegt.The two
Auch die erste Rotationsachse, um die der Trokar 18 rotieren kann, liegt in der Klammerebene. Um die Rotation zu ermöglichen, ist im Bereich der Spitzen 22 jedes der beiden Schenkel 21 ein Radiaxlager 28 ausgebildet. Das Aufnahmeelement 24 ist als Achse ausgebildet und wird bei geschlossenen Schenkeln von den Radiaxlagern 28 an einer axialen Bewegung gehindert. Dazu liegt es mit Achsendbereichen 29 in den Radiaxlagern 28. Außerdem weist das Aufnahmeelement 24 zur Durchführung des Trokars 18 senkrecht durch die Achse eine durchgehende Öffnung 30 auf. In diese wird der Trokar 18 eingeschoben. Das Aufnahmeelement 24 ist auswechselbar und kann in verschiedenen Größen, d.h. mit Öffnungen verschiedener Durchmesser bereitgestellt werden. Auf diese Weise ist immer eine optimale Anpassung an den jeweiligen Trokar 18 möglich, da für verschiedene Instrumente verschiedene Trokare verwendet werden können. Trokare für Endoskope sind beispielsweise etwas dicker als Trokare für Scheren oder Skalpelle.The first axis of rotation, about which the
Der Trokar 18 weist eine Instrumentenaufnahme 44 auf, an die sich davon abstehend ein Durchführungselement 45 anschließt. Das Durchführungselement 45 weist dabei eine sich von der Instrumentenaufnahme 44 abstehend verjüngende Form eines Kegelstumpfes auf. Der Kegelwinkel ist extrem spitz, bevorzugt weniger als 1°, besonders bevorzugt weniger als 0,1°; auf diese Weise kann eine entsprechende Eindringtiefe vorgegeben werden: je spitzer der Kegelwinkel, desto höher die Eindringtiefe, wenn das gleiche Aufnahmeelement 24 verwendet wird. Da die Kegelform sehr spitz ist, wird dennoch ein fester Sitz des Trokars 18 im Aufnahmeelement 24 ermöglicht.The
Die Schenkel und der Rücken des Klammerelements sind bevorzugt einstückig ausgebildet und sind bevorzugt aus Kunststoff gefertigt. Dies ermöglicht zum einen geringe Herstellungskosten und zum anderen die Auslegung des Klammerelements als Einwegartikel, der nach jeder Operation entsorgt wird, was hygienisch vorteilhaft ist.The legs and the back of the clamp element are preferably formed in one piece and are preferably made of plastic. On the one hand, this enables low manufacturing costs and, on the other hand, the design of the clip element as a disposable item that is disposed of after each operation, which is hygienically advantageous.
Insbesondere bei der einstückigen Fertigung von Schenkeln 21 und Rücken 23, aber auch bei anderen Arten der Verbindung, beispielsweise einer Schraub- oder Klebeverbindung weist die aus Schenkeln und Rücken gebildete Klammer bevorzugt eine Federwirkung auf, die dazu führt, dass die Schenkel 21 bei elastischer Auslenkung aus einer Ruheposition, die hier beispielsweise die in
Bei einer Federwirkung der Klammer kann das Aufnahmeelement 24 grundsätzlich auch von Hand in die Radiaxlager 28 an den Spitzen 22 der Schenkel 21 eingesetzt werden, dies ist jedoch aufwendig und umständlich, bei unsachgemäßer Handhabung kann das Klammerelement 21 dabei auch zerstört werden.In the event of a spring action of the clip, the receiving
Um das Einsetzen des Aufnahmeelements 24 in das Klammerelement 20 zu erleichtern, weist die Trokarhalterung daher auch einen Klammermechanismus zum Öffnen und Schließen der Schenkel auf. Der Klammermechanismus umfasst mindestens einen Stift 31, der in einem von Null verschiedenen Winkel zur Klammerebene in einem Schenkel 21 fixiert ist. In den Zeichnungen sind beispielhaft zwei Stifte 31 gezeigt, die in von Null verschiedenen Winkeln zur Klammerebene in den Schenkeln 21 fixiert sind, in jedem Schenkel 21 ist ein Stift 31, der beispielsweise aus Edelstahl gefertigt sein kann, fixiert. Diese Stifte 31 sind in der Explosionszeichnung in
Der Klammermechanismus umfasst außerdem ein Führungselement 32, in welches eine Anzahl der Stifte 31 entsprechende Anzahl von Langlöchern 33 mit Schmalseiten 34 und Längsseiten 35 eingebracht sind. Im gezeigten Beispiel weist das Führungselement 32 daher zwei Langlöcher 33 auf, das Führungselement 32 ist in
Eine andere Möglichkeit, die eine noch kompaktere und stabilere Bauform ermöglicht und die in den in den Zeichnungen dargestellten Beispielen realisiert ist, besteht darin, die Bewegungsachse als zweite Rotationsachse 36 auszugestalten, diese zweite Rotationsachse liegt senkrecht zur Klammerebene, in den
Im nicht ausgelenkten Zustand, d.h. im geschlossenen Zustand sind die Schenkel 21 in ihrer Ruheposition, d.h. es wirken keine strukturbedingten, internen Rückstellkräfte auf sie. Um das Schließen der Klammer zu erleichtern ist es daher vorteilhaft, wenn der Bereich des mindestens einen Langlochs 33, der näher an derjenigen Schmalseite 34 liegt, welche wiederum näher an der zweiten Rotationsachse 36 liegt und den geschlossenen Zustand der Klammer definiert, als gerader Abschnitt 37 des Langlochs 33 ausgeführt ist, dieser gerade Abschnitt 37 weist keine Krümmung auf und wirkt als sogenannter toter Bereich, da in diesem Bereich keine Verstellung stattfindet. Auf diese Weise lassen sich mögliche Fertigungstoleranzen berücksichtigen und es kann sichergestellt werden, dass das Führungselement 32 in eine Ruheposition gebracht und dort fixiert werden kann. Die Stifte 31 sind hier senkrecht zur Klammerebene angeordnet, ebenso wie die zweite Rotationsachse 36. Die Stifte 31 können gegenüber den Langlöchern 33 eine geringe Übermaßpassung aufweisen, um ein unwillkürliches Verstellen zu verhindern. Alternativ oder ergänzend kann das Führungselement 32 in den beiden Endpositionen, die die maximal mögliche Öffnung und die geschlossene Klammer definieren, auch fixiert werden. Um die Klammer im geöffneten Zustand zu fixieren und ein sicheres Auswechseln des Aufnahmeelements 24 zu ermöglichen, weisen die näher an der Bewegungsachse liegenden Langlöcher 33 im Bereich derjenigen Schmalseiten 34, die zur geöffneten Klammer korrespondieren, eine Ausbuchtung 38 auf, in welche der jeweilige Stift 31 auf Grund der intrinsischen Rückstellkraft der Klammer einrasten kann. Auch im Bereich der anderen Schmalseite 34 ist es möglich, eine solche Ausbuchtung vorzusehen, wenn die Schenkel 21 des Klammerelements 20 immer vorgespannt bleiben sollen, also vom Führungselement 32 daran gehindert werden, in eine Ruhestellung, bei der keine Rückstellkraft wirkt, zu gelangen. In diesem Fall kann auch der gerade Abschnitt 37 des Langlochs 33 entfallen.In the undeflected state, ie in the closed state, the
In der hier gezeigten Ausführung ist das Führungselement 32 auf einer mit den Klammerelement 20 verbundenen Zunge 39 - dargestellt beispielsweise in
Insbesondere bei einem Führungselement 32, wie es hier u.a. in
In der hier gezeigten Ausführung weist das Führungselement 32 einen Hebel 40 auf.
Um das Führungselement 32 in der geöffneten Position zu fixieren, weisen die Langlöcher an ihrer Innenseite, d.h. an derjenigen Längsseite 35, die der Bewegungsachse - hier der zweiten Rotationsachse 36 - näher liegen, Ausbuchtungen 38 im Bereich der entsprechenden Schmalseiten 34, die dem geöffneten Zustand entsprechen, auf, wie oben bereits beschrieben. Entsprechende Ausbuchtungen 38 lassen sich alternativ oder ergänzend auch für den geschlossenen Zustand an der andern Schmalseite 34 und der anderen Längsseite 35 anbringen, wobei ein Halt darin nur dann gesichert ist, wenn die Klammer unter Vorspannung steht.In order to fix the
Ergänzend oder alternativ sind vorteilhaft am Hebel 40 und am Klammerelement 20 Fixierungsmittel ausgebildet oder angeordnet, die bevorzugt als Rastverbindung ausgebildet sind, mittels welcher der Hebel 40 mindestens bei geschlossenen Schenkeln 21 in seiner Position gesichert ist. Beispielhaft umfasst die Rastverbindung hier eine auf dem Klammerelement im Bereich des Rückens 23 angeordnete Rastnase 42 und ein am Hebel 40 ausgebildetes, zur Rastnase 42 korrespondierendes Rastloch 43. Auf diese Weise wird der Hebel 40 und damit auch das Führungselement 32 gegen unwillkürliches Öffnen bei geschlossener Klammer gesichert, was insbesondere dann vorteilhaft ist, wenn die Klammer nicht unter Vorspannung steht.In addition or alternatively, fixing means are advantageously formed or arranged on the
Alternativ zu der in
Diese letztgenannte Ausführung lässt sich auch mit der Ausführung mit Stiften kombinieren, um eine höhere Sicherheit zu gewährleisten. Ansonsten kann bei der Ausführung mit Exzenterelementen auch auf die Stifte 31 verzichtet werden, was die Herstellung vereinfacht und kostengünstiger macht, da für den Klammermechanismus dann keine Metallteile mehr benötigt werden.This latter version can also be combined with the version with pins to ensure greater security. Otherwise, pins 31 can also be dispensed with in the embodiment with eccentric elements, which simplifies production and makes them more cost-effective since metal parts are then no longer required for the clamping mechanism.
Die vorangehend beschriebene Trokarhalterung ermöglicht aufgrund ihrer einfach zu bedienenden Klammerfunktion ein einfaches Wechseln des Aufnahmeelements 24 und somit einen einfachen Wechsel zwischen Trokaren 18 verschiedener Durchmesser. Durch den zusätzlichen Kippfreiheitsgrad für den Trokar 18 wird die Belastung der Gewebedecke des Patienten reduziert, so dass das die Trokarhalterung führende Gerät kompakter ausgelegt werden kann. Eine Sterilitätsgrenze wird zwischen den Klammerelement 20 und dem Basiselement 19 durch Verwendung einer Sterilisationsfolie hergestellt, so dass hier der Sterilitätsbereich eine sehr große Ausdehnung in Bezug auf die Entfernung vom Patienten hat, was größtmögliche Sicherheit garantiert. Insbesondere wird das Klammerelement 20, aber auch das Basiselement 19 sowie weitere wichtige Teile wie Aufnahmeelement 24, Führungselement 32, Hebel 40 etc. aus Kunststoff gefertigt, so dass eine kostengünstige Herstellung möglich ist und das Klammerelement 20 auch als Einwegelement ausgelegt werden kann, was die Sicherheit zusätzlich erhöht.Due to its easy-to-use clamp function, the above-described trocar holder enables the receiving
- 11
- Standfußstand
- 22
- Tragsäulesupport column
- 33
- Auslegerboom
- 44
- Gabelstrukturfork structure
- 55
- Manipulatormanipulator
- 66
- Instrumentenhalterinstrument support
- 77
- Patientenliegepatient support
- 88th
- Liegenstandfußare stand
- 99
- Patientpatient
- 1010
- Steuervorrichtungcontrol device
- 1111
- Handgriffhandle
- 1212
- Betrachtungseinrichtungviewer
- 1313
- InstrumententrägervorrichtungInstrument support device
- 1414
- Schlittencarriage
- 1515
- erstes Armgliedfirst arm link
- 1616
- zweites Armgliedsecond arm link
- 1717
- drittes Armgliedthird arm link
- 1818
- Trokartrocar
- 1919
- Basiselementbase element
- 2020
- Klammerelementclip element
- 2121
- Schenkelleg
- 2222
- Spitzetop
- 2323
- Rückenmove
- 2424
- Aufnahmeelementreceiving element
- 2525
- Schnappelementsnap element
- 2626
- Schnappnasesnap lug
- 2727
- Drucktastepushbutton
- 2828
- RadiaxlagerRadiaxlager
- 2929
- AchsendbereichAchsendbereich
- 3030
- Öffnungopening
- 3131
- Stiftpen
- 3232
- Führungselementguide element
- 3333
- LanglochLong hole
- 3434
- Schmalseitenarrow side
- 3535
- Längsseitelong side
- 3636
- Rotationsachseaxis of rotation
- 3737
- gerader Abschnittstraight section
- 3838
- Ausbuchtungbulge
- 3939
- Zungetongue
- 4040
- Hebellever
- 4141
- Griffelementhandle element
- 4242
- Rastnaselocking lug
- 4343
- Rastlochcatch hole
- 4444
- Instrumentenaufnahmeinstrument holder
- 4545
- DurchführungselementThrough element
- 4646
- Sterilisationsfoliesterilization wrap
Claims (19)
Applications Claiming Priority (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
DE102018115435.6A DE102018115435A1 (en) | 2018-06-27 | 2018-06-27 | Trokarhalterung |
Publications (3)
Publication Number | Publication Date |
---|---|
EP3586783A2 true EP3586783A2 (en) | 2020-01-01 |
EP3586783A3 EP3586783A3 (en) | 2020-01-15 |
EP3586783B1 EP3586783B1 (en) | 2021-01-27 |
Family
ID=66998062
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
EP19178340.6A Active EP3586783B1 (en) | 2018-06-27 | 2019-06-05 | Trocar holder |
Country Status (4)
Country | Link |
---|---|
US (1) | US11109923B2 (en) |
EP (1) | EP3586783B1 (en) |
CN (1) | CN110638505A (en) |
DE (1) | DE102018115435A1 (en) |
Families Citing this family (10)
Publication number | Priority date | Publication date | Assignee | Title |
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CN105636543B (en) | 2013-08-15 | 2018-07-13 | 直观外科手术操作公司 | Instrument sterile adaptor driving interface |
CN109247987B (en) | 2013-08-15 | 2021-07-23 | 直观外科手术操作公司 | Preloaded surgical instrument interface |
JP6719376B2 (en) | 2013-08-15 | 2020-07-08 | インテュイティブ サージカル オペレーションズ, インコーポレイテッド | Driven elements of robot equipment |
CN109602495B (en) * | 2013-08-15 | 2021-05-11 | 直观外科手术操作公司 | Instrument sterile adapter drive features |
CN111743609A (en) * | 2020-07-31 | 2020-10-09 | 北京大学第三医院(北京大学第三临床医学院) | Intraspinal anesthesia puncture needle and puncture system |
CN113855221B (en) * | 2021-12-01 | 2022-03-25 | 真健康(北京)医疗科技有限公司 | A surgical robot that is used for terminal needle holder of ablation needle and carries out ablation |
CN114917013B (en) * | 2022-04-12 | 2024-03-22 | 吉林大学 | Multi-pose Kirschner wire clamp holder for robot-assisted fracture reduction operation |
CN114711920B (en) * | 2022-04-28 | 2024-08-23 | 哈尔滨理工大学 | Flexible needle clamping mechanism |
WO2023225288A1 (en) * | 2022-05-20 | 2023-11-23 | Standard Bariatrics, Inc. | Surgical instruments for robotic-assisted surgery and methods of using the same |
CN118267106A (en) * | 2024-04-08 | 2024-07-02 | 北京天智航医疗科技股份有限公司 | Auxiliary operation device |
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WO2003092518A1 (en) | 2002-05-02 | 2003-11-13 | Gmp Surgical Solutions, Inc. | Apparatus for positioning a medical instrument relative to a patient |
EP3103410A1 (en) | 2015-06-12 | 2016-12-14 | avateramedical GmbH | Device and method for robot-assisted surgery |
EP3111876A2 (en) | 2005-09-30 | 2017-01-04 | Intuitive Surgical Operations, Inc. | Surgical accessory clamp and system |
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DE3924099A1 (en) * | 1989-07-20 | 1991-01-31 | Manumatik Produktionssysteme G | STRAIGHT GUIDE OF SWIVEL JOINTS |
DE4326618C2 (en) * | 1993-03-04 | 1995-05-18 | Wolfgang Daum Medizintechnik | Manipulator hand |
EP0699053B1 (en) * | 1993-05-14 | 1999-03-17 | Sri International | Surgical apparatus |
US5792135A (en) * | 1996-05-20 | 1998-08-11 | Intuitive Surgical, Inc. | Articulated surgical instrument for performing minimally invasive surgery with enhanced dexterity and sensitivity |
TW375522B (en) * | 1996-10-24 | 1999-12-01 | Danek Medical Inc | Devices for percutaneous surgery under direct visualization and through an elongated cannula |
JP2003290238A (en) * | 2002-03-29 | 2003-10-14 | Masayuki Nakao | Medical treatment appliance |
DE50200016D1 (en) * | 2002-05-06 | 2003-07-31 | Storz Karl Gmbh & Co Kg | Device for holding trocar sleeves |
DE10231724B4 (en) * | 2002-07-13 | 2004-05-13 | Kuka Roboter Gmbh | Supporting collar |
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DE102006055172A1 (en) * | 2006-11-23 | 2008-05-29 | Karl Storz Gmbh & Co. Kg | Device for clamping fixing on cylindrical components of medical instruments |
WO2012112622A2 (en) * | 2011-02-14 | 2012-08-23 | The Board Of Trustees Of The Leland Stanford Jr. University | Apparatus, systems, and methods for performing laparoscopic surgery |
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2018
- 2018-06-27 DE DE102018115435.6A patent/DE102018115435A1/en not_active Withdrawn
-
2019
- 2019-06-05 EP EP19178340.6A patent/EP3586783B1/en active Active
- 2019-06-19 US US16/446,452 patent/US11109923B2/en active Active
- 2019-06-24 CN CN201910552307.5A patent/CN110638505A/en active Pending
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WO2003092518A1 (en) | 2002-05-02 | 2003-11-13 | Gmp Surgical Solutions, Inc. | Apparatus for positioning a medical instrument relative to a patient |
EP3111876A2 (en) | 2005-09-30 | 2017-01-04 | Intuitive Surgical Operations, Inc. | Surgical accessory clamp and system |
EP3103410A1 (en) | 2015-06-12 | 2016-12-14 | avateramedical GmbH | Device and method for robot-assisted surgery |
Also Published As
Publication number | Publication date |
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EP3586783A3 (en) | 2020-01-15 |
CN110638505A (en) | 2020-01-03 |
US11109923B2 (en) | 2021-09-07 |
US20200000532A1 (en) | 2020-01-02 |
EP3586783B1 (en) | 2021-01-27 |
DE102018115435A1 (en) | 2020-01-02 |
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